skip to main content

Gastric Outlet Obstruction — MRCP Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardGastroenterologyGastric Outlet ObstructionMRCP Part 1UKMLAPARA

A 9-year-old with cystic fibrosis has one F508del CFTR allele and is clinically suitable for either vanzacaftor-tezacaftor-deutivacaftor or ivacaftor-tezacaftor-elexacaftor. After shared discussion, neither has a clinical advantage. What does NICE require?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Use the least expensive suitable CFTR-modulator combination

The best answer is “Use the least expensive suitable CFTR-modulator combination”. Vanzacaftor-tezacaftor-deutivacaftor is an option from age 6 when at least one F508del mutation is present. When it and ivacaftor-tezacaftor-elexacaftor are both suitable, NICE requires discussion of advantages and disadvantages followed by use of the least expensive option, taking administration and commercial costs into account. Age 9 and one F508del allele satisfy eligibility; appraisal date, age under 12 and homozygosity do not create the proposed restrictions, and the two triples are alternatives rather than combination therapy.

Reference: NICE TA1085, Vanzacaftor-tezacaftor-deutivacaftor for cystic fibrosis: https://www.nice.org.uk/guidance/ta1085/chapter/1-Recommendations